A Patient’s Guide to
Ankle Fusion
Orthopedic and Sports Physical Therapy
245 North College
Lafayette, LA 70506
Phone: 337.232.5301 Fax: 337.237.6504
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DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases,
Guide to
Ankle
physical conditions, ailmentsA
or Patient's
treatments. The information
should
NOT be Fusion
used in place of a visit with your health care provider, nor should you disregard
the advice of your health care provider because of any information you read in this booklet.
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Phone: 337.232.5301 Fax: 337.237.6504
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2
A Patient's Guide to Ankle Fusion
lower end of the tibia (shinbone), the fibula
(the small bone of the lower leg), and the talus
(the bone that fits into the socket formed by
the tibia and fibula). The talus sits on top of
the calcaneus (the heelbone).
Introduction
An ankle fusion is a surgical procedure
that is usually done when an ankle joint
becomes worn out and painful, a condition
called degerative arthritis. Ankle fusion is
sometimes called ankle arthrodesis.
Probably the most common cause of
degenerative arthritis of the ankle is an
ankle fracture. Many years after a serious
fracture, the joint may wear out and become
painful. Just as an out-of-balance piece of
machinery wears out faster, a joint that is
out of balance after it heals from a fracture
can wear out faster than normal. This
process may take many years. Other types
of arthritis can lead to a painful ankle joint
as well. For example, rheumatoid arthritis
can destroy the ankle, leading to a painful
joint.
The talus moves mainly in one direction. It
works like a hinge to allow your foot to move
up and down.
This guide will help you understand
• why an ankle fusion becomes necessary
• what happens during surgery
• what to expect during your recovery
Anatomy
How does the ankle joint work?
The ankle joint is made up of three bones: the
Ligaments on both sides of the ankle joint
help hold the bones together. Many tendons
cross the ankle to move the ankle and the
toes. (Ligaments connect bone to bone, while
tendons connect muscle to bone.)
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A Patient's Guide to Ankle Fusion
the development of artificial joints this was
the primary operation available to treat an
extremely painful joint. In some cases, fusion
is still the best choice.
Tendons
The large Achilles tendon at the back of the
ankle is the most powerful tendon in the foot.
It connects the calf muscles to the heel bone
and gives the foot the power for walking,
running, and jumping.
Inside the joint,
the bones are
covered with a
slick material
called articular
cartilage.
Articular cartilage
is the material
that allows the
bones to move
smoothly against
one another in the
joints of the body.
For the ankle, a fusion is a very good operation
for treating a worn-out joint. This is especially
true if the patient is young and very active. An
ankle fusion, if successful, is not in danger of
wearing out like an artificial ankle. An ankle
fusion should last the patient a lifetime. But it
is also important that the other foot joints are
normal. A fusion keeps the ankle joint from
moving during walking and other activities, so
the other foot joints will need good mobility.
Preparation
What do I need to do before surgery?
The decision to proceed with surgery must
be made jointly by you and your surgeon.
You need to understand as much about the
procedure as possible. If you have concerns or
questions, you should talk to your surgeon.
Once you decide on surgery, you need to take
several steps. Your surgeon may suggest a
complete physical examination by your regular
doctor. This exam helps ensure that you are
in the best possible condition to undergo the
operation.
Articular cartilage
The cartilage lining is about one-quarter of
an inch thick in most joints that carry body
weight, such as the ankle, hip, or knee. It is
soft enough to allow for shock absorption but
tough enough to last a lifetime, as long as it is
not injured.
On the day of your surgery, you will probably
be admitted to the hospital early in the
morning. You shouldn't eat or drink anything
after midnight the night before. The amount of
time patients spend in the hospital varies. You
will need to stay until your medical condition
has stabilized and you can safely use crutches
or a walker.
Rationale
Surgical Procedure
What does the surgeon hope to accomplish?
What happens during surgery?
An ankle fusion actually removes the surfaces
of the ankle joint and allows the tibia to grow
together, or fuse, with the talus. There are
operations for many joints in the body that
surgically fuse the joint to control pain. Before
Open Method
Several different operations have been developed to perform an ankle fusion. The basic
procedure in each operation remains the same,
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A Patient's Guide to Ankle Fusion
however. The most common way that an
ankle fusion is done is by making an incision
through the skin to open the joint. Once the
joint is opened, the surgeon uses a surgical saw
to remove the articular surfaces of the ankle
joint. Once the articular cartilage is removed
on both sides of the joint, the body will try to
heal the two surfaces together just as if it were
fractured or broken.
It is important when the surfaces are removed
that the angles of the cut surfaces are correct.
When the tibia is brought against the talus,
the foot should be at a right angle to the lower
leg. Once the cuts are made the bones must
be held in place while they fuse. This can be
done using large metal screws and metal plates
if necessary.
The screws are
usually under
the skin and are
not removed
unless they
begin to rub and
cause pain.
In some cases,
especially if the
fusion is being
done because
of an infection or a failed
initial fusion, an
apparatus called
an external
fixator is used
to hold the
bones together
while they heal.
This apparatus
has metal pins
that are inserted
through the skin and into the bone. The metal
pins are connected to metal rods and bolts
outside the skin that hold the bones in position
while the ankle fuses. The fixator is removed
after the bones have healed, usually in 12 to 15
weeks.
Arthroscopic Method
Some surgeons have performed ankle fusions
with the help of the arthroscope. The arthroscope is a miniature TV camera that is inserted
into the ankle joint through a small incision.
Using the arthroscope to watch, other instruments are inserted into the ankle joint to
remove the cartilage surface. The cartilage
surface is removed using a small rotary cutting
tool. Once the surfaces are prepared, screws
are placed through small incisions in the
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A Patient's Guide to Ankle Fusion
the ankle can be injured. This may result in
numbness in the foot if the nerves are injured.
Severe injuries of the blood vessels of the foot
could lead to the need for an amputation.
Infection
Following surgery, it is possible that the
surgical incision can become infected. This
will require antibiotics and possibly another
surgical procedure to drain the infection.
Nonunion
skin to hold the bones together as they heal,
or fuse. This procedure is not significantly
different from the open procedure except that
the incisions are smaller.
Complications
What might go wrong?
As with all major surgical procedures, complications can occur. This document doesn't
provide a complete list of the possible complications, but it does highlight some of the most
common problems. Some of the most common
complications following ankle fusion are
• anesthesia
• nerve or blood vessel injury
• infection
• nonunion of the bones
• malunion of the bones
Anesthesia
Problems can arise when the anesthesia given
during surgery causes a reaction with other
drugs the patient is taking. In rare cases, a
patient may have problems with the anesthesia
itself. In addition, anesthesia can affect lung
function because the lungs don’t expand as
well while a person is under anesthesia. Be
sure to discuss the risks and your concerns
with your anesthesiologist.
Nerve or Blood Vessel Injury
Sometimes the bones do not fuse as planned.
This is called a nonunion, or pseudarthrosis.
(The term pseudarthrosis means false joint.)
This condition requires another operation to
add bone graft and perhaps additional fixation.
The bones need to be completely immobilized
to fuse, so an external fixator may be needed
to help hold the bones in position as they heal.
Malunion
Another possible complication is that the bones
may heal in the wrong position. This is called
a malunion. If the malunion is too extreme and
causes problems with walking, another operation may be required to try to achieve a better
position of healing.
After Surgery
What happens after surgery?
After surgery, your ankle will be wrapped in a
padded plaster cast. This will be removed after
two weeks and replaced with a short-leg cast.
You will not be permitted to put weight down
on your foot until it is certain the bones are
fusing. This usually takes between eight and
12 weeks.
You should keep your leg elevated above the
level of your heart for several days to avoid
swelling and throbbing. Keep it propped up on
a stack of pillows when sleeping or sitting up.
During surgery, it is possible that either the
nerves of the foot or the blood vessels around
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A Patient's Guide to Ankle Fusion
Rehabilitation
What will my recovery be like?
An ankle
brace will
replace the
cast after
eight to 12
weeks. Your
surgeon will
take X-rays
frequently
to see if
the bones
are fusing
together. You will probably need to use
crutches for most of the time you wear the
cast. As the fusion grows stronger, you will
begin to put more weight on your foot when
walking. You may need the help of a physical
therapist to learn to walk smoothly and
without a limp.
Once the fusion has completely healed, you
will be fitted with several special shoe modifications to make walking easier. An insert
in the shoe called a SACH foot is sometime
useful to help you walk more normally. This
heel cushion compresses as you put your
weight on the foot and allows the foot to roll
more normally as you step. Another useful
modification of the shoe is a rocker sole.
Unlike a typical flat shoe sole, the rocker sole
is rounded, allowing your foot to roll as you
move through a step.
While you won't be able to run normally after
an ankle fusion, a successful operation should
result in a nearly natural walking gait.
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A Patient's Guide to Ankle Fusion
Notes
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